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THE 
JOHNS HOPKINS 
HOSPITAL 


7 


_ PUBLISHED BY 
THE JOHNS HOPKINS 
HALF-CENTURY COMMITTEE 
BALTIMORE 


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FOREWORD 


y 


N the tenth day of March, 1873, there 
was addressed to twelve of the leading 
men of Baltimore a remarkable docu- 


ment. It 1s not too muchto say that this 





communication, in its far-reaching 
effects on social and educational progress, was one of 
world-wide importance. 

This document was the letter of Johns Hopkins, set- 
ting forth to his trustees his hopes and plans for the 
future of the hospital which now bears his name. 

The new hospital, he wrote, should ‘compare favor- 
ably with any other institutions of like character in this 
country or Europe;”’ it should admit “‘the indigent poor. . 
without regard to sex, age or color. . and. . without 


y) 


charge;” it should be staffed by “‘surgeons and physi- 
cians of the highest character and greatest skill;”’ it 
should ‘establish a training school for nurses . . to 


benefit the whole community;”? and it should ‘‘ulti- 


FOREWORD 


mately form a part of the Medical School of that Uni- 
versity for which I have made ample provision in my will.” 

These conditions, together with the unusual provi- 
sions for grounds, buildings and endowment, marked 
Johns Hopkins as a man of rare foresight. Time, and the 
faithful carrying out of his trust, have made his name 
known in the most distant parts of the world, and have 
established the Johns Hopkins Hospital as the central 
unit of what many believe to be one of the leading 
medical centers of the world. 

The purpose of the following presentation is to ex- 
plain in a brief but comprehensive manner the signifi- 
cance of the Johns Hopkins Hospital as an agency for 
the treatment and care of persons afflicted by acute dis- 
eases, for the pursuit of medical research, and for advanc- 
ing the standards of medical education and the tech- 


nique of modern medical practice. 


Henry D. Harian 
Chairman of the Board of Trustees 


Winrorp H. Smitu, M.D. 
Director of the Hospital 


PART ONE 


THE JOHNS HOPKINS HOSPITAL 
WHAT IT IS 


7 


1. THE TREND TOWARD UNITY 





[1TH hospitals, as with newspapers, banks, railroads 
| and great manufactories, the trend today is toward 
concentration, toward the establishment of more 
complete and effective units. And especially is this 
Stee == true of organizations whose activities are nation 
wide. With hospitals this trend is toward the establishment of 
great medical centers, where there can be brought to bear 
upon the treatment of disease, and for the purpose of educating 


physicians, all the knowledge and facilities available to modern 


medical science. 


Such centers have existed for many 
years in Europe, in Berlin, Vienna, Paris, 
London and a number of other cities. Such 
centers are either planned or in develop- 
ment in Boston, New York, Chicago, Phil- 
adelphia, Nashville and Rochester. 


AN ESTABLISHED EXAMPLE 


Baltimore, in possessing the Johns Hop- 
kins Hospital and the medical branches of 
the Johns Hopkins University, has had 
such a center for many years, and, with 
the establishment since 1912 of the Johns 
Hopkins School of Hygiene and Public 


Health and of four new clinical institutes 
and the financing of a fifth, many believe 
that the Johns Hopkins medical center is 
today the most thorough and effective 
mobilization, in one compact group, of 
medical resources in the New World. 


NATIONAL IN SCOPE 


This movement for the organization of 
great medical centers has arisen in many 
instances because in certain municipalities 
there has been an ever increasing realiza- 
tion that the medical facilities which serve 
the immediate community should be bet- 


6 THE JOHNS HOPKINS HOSPITAL 


ter organized. The Johns Hopkins Hospi- 
tal and the medical institutions with 
which it is affiliated, however, constitute 
more than a local medical center, for ap- 
proximately 80 per cent. of its private 
patients and 33 per cent. of all its patients 
come from homes outside of Baltimore. 

The Johns Hopkins Hospital has been 
and is a national and even an international 
hospital and from two viewpoints is one 
of the leading hospitals of the world. First, 
as a center for the treatment of all manner 
of acute diseases for rich and poor alike; 
and second, as a center for the training of 
physicians and surgeons. 

The combination of these two aims has 


proved both logical and effective. Through 
its methods in treating disease and in 
teaching students the Hospital has pro- 
moted a large amount of research work 
which has advanced medical knowledge 
and furthered the conquest of disease. 


AN IMMEDIATE OPPORTUNITY 


The Johns Hopkins Hospital is today one 
of the great hospitals of all time. In addi- 
tion it presents an outstanding opportu- 
nity for the promotion of medical progress 
in the future and for the establishment of 
an even greater institution, such as may 
well equal any like venture, past or pres- 
ent, for the welfare of humanity. 


u. THE INSTITUTION 


Johns Hopkins’ original gift to the Hospi- 
tal was $3,228,404.84. Because he directed 
that it should be the equal of any like in- 
stitution in the world, such an endow- 
ment was sufficient only to provide income 
for its operating expenses even at the be- 
ginning. For that reason it was necessary 
to allow the interest to accumulate for 
many years in order that the buildings 
might be erected without impairing the 
principal of the endowment. 

Thus, it was not until 1889 that the 
Hospital was completed and opened. 


GROWTH IN CAPACITY 


The Johns Hopkins Hospital of 1889 was 
equipped with 230 beds. Its founder ex- 
pressed the hope that it “might ultimately 
be able to receive four hundred patients.” 
Today the total number of beds is 683, 
of which 473 are in the wards and 190 in 
the Marburg Building and other divisions 


for private patients. With the completion 
of the Wilmer Institute, funds for which 
have already been provided, the total bed 
capacity of the Johns Hopkins Hospital 
will be 743. 

THE GENERAL HOSPITAL 


The aerial view, used as a frontispiece, in- 
dicates the physical proportions of the 
Hospital. Its grounds include fourteen 
and one-half acres—more than four city 
blocks. Its buildings, exclusive of the Med- 
ical School and the School of Hygiene and 
Public Health, with which it is associated, 
include twenty-one structures. 

These buildings not only house the va- 
rious and complex medical and surgical 
services of a great general hospital, as 
illustrated on the accompanying page, but 
also four great clinical institutes, each of 
which is a special hospital and research 
center in itself, yet all are integrated in the 
general hospital organization. 


WTI LS. 








GENERAL HOSPITAL 


Total No. of Beds 
WEE DIGAINCLINIG, O27 ard Beds) Met yale lie aera eel, 92 
GENERAL MEDICAL METABOLIC DISEASES NERVOUS DISEASES 
TUBERCULOSIS GASTRO-INTESTINAL DISEASES DISEASES OF THE HEART 
SURGICAL CLINIC, 93 Ward Beds 


GENERAL SURGERY EAR, NOSE AND THROAT DISEASES OF THE EYE 
BRAIN SURGERY PLASTIC SURGERY ORTHOPEDIC SURGERY DENTAL CLINIC 


WIARBURGIDUILDING,) oo Ptivete Rooms |) Wiel ry 8. ils ke OP eri 1a 
PAVILION FOR PRIVATE PATIENTS IN ALL GENERAL SERVICES 


CLINICAL INSTITUTES 


Brapy UROLOGICAL INSTITUTE, 21 Ward Beds, 20 Private Rooms, 19 Cubicles , 60 
GENITO-URINARY DISEASES OF MEN 
WomMaNn’s CLINIC, 126 Ward Beds, 10 Private Rooms, 18 Cubicles ‘ 3 ; RL ha 
OBSTETRICS GENITO-URINARY DISEASES OF WOMEN GYNECOLOGY 


CHILDREN’s Criinic (Harriet Lane) 90 Ward Beds, 10 PrivateRooms . . I00 
MEDICAL DISEASES OF CHILDREN 


Puipps PsycHIATric CLINIC, 70 Ward Beds, 18 PrivateRooms . . . . 88 
MENTAL DISEASES 


Preseni i oral of Beds ai. ||) . | tana: O83 


WILMER INSTITUTE, 4° Ward Beds, 10 Private Rooms, 10 Cubicles . . . 60 
(Will be opened within the coming year) 
DISEASES OF THE EYE 


Total Number of Beds Next Year. 


HOSPITAL LABORATORIES 


PATHOLOGICAL CHEMICAL BACTERIOLOGICAL 
SEROLOGICAL PHYSIOLOGICAL AND CARDIOGRAPHIC 


(For preparation (For diagnosis of the physical action of the heart 
of serums) and other bodily organs) 


TUBERCULOSIS WASSERMAN 


(Throughout all the services there are distributed a large number of smaller research 
laboratories, many of which are supported by the Medical School. In the Harriet 
Lane Home, for instance, there are fourteen such laboratories) 


SPECIAL DEPARTMENTS 


ExecutivE DeparrMent—Handles the administrative affairs of the Hospital 
and trains hospital executives. 
SociaL SERVICE DEPARTMENT—Handles approximately 12,000 cases a year. 
Nursinc DEPARTMENT AND SCHOOL FOR NursEs—Includes 250 student nurses 
and 72 graduates as head nurses and instructors. Has trained 1,260 nurses. 
PosTGRADUATE CouRSES FOR PHYSICIANS Course For DIETICIANS 
Mepicav Liprary PHoToGRAPHIC DEPARTMENT 
WorKSHOP FOR APPLIANCES FOR CRIPPLED CHILDREN 











8 THE JOHNS HOPKINS HOSPITAL 





CHILDREN’S DISEASES 


The first of these clinical institutes to be 
established was the Harriet Lane Home 
for Invalid Children, which was opened 
in 1912. It was erected with funds pro- 
vided through the will of Mrs. Harriet 


Lane Johnston of Washington, D. C. This | =the FS 


institute is devoted to the study and treat- 
ment of children’s diseases. Last year it 
cared for 1,334 bed patients and approxi- 
mately 18,000 additional children re- 
ceived treatment in its dispensary. The 
work of its staff, the members of the Hos- 
pital’s Department of Pediatrics, have 
led to the discovery in its wards and lab- 
oratories of a large portion of that knowl- 
edge which made possible the introduction 
of successful methods for the treatment of 
rickets, tetany, acidosis and a large num- 
ber of the diseases of children which are 
due to nutritional causes. The fact that 
children with bowlegs and heads deformed 
by rickets are rapidly ceasing to bea com- 
mon sight is due to a great extent to the 
work of this department of the Hospital. 


UROLOGICAL CLINIC 


The Brady Urological Institute, in which 
thousands of persons suffering from dis- 
eases of the genito-urinary system have 
received treatment, was founded byJames 
B. Brady. The methods developed in this 
institute have reduced the mortality in 
operations for hypertrophy of the pros- 
tate gland from some 20 per cent. to 2 per 
cent. In its laboratories there has been 
discovered a long series of compounds for 
the treatment of disease. Among these are 
mercurochrome, an antiseptic of wide 
value not only in the treatment of urinary 
diseases but also for the purpose of com- 





COURT OF THE PHIPPS CLINIC 


bating blood poisoning and similar dis- 
orders, and flumerin, the introduction of 
which marked a new advance in intraven- 
ous treatment of syphilis. 


PSYCHIATRIC CLINIC 


A third clinical institute was established 
through the gifts of Mr. and Mrs. Henry 
Phipps. This is the Phipps Psychiatric 
Clinic for the study and treatment of men- 
tal diseases. Mental disease still presents 
some of the most trying problems which 
confront the physician. This clinic is one 
of the few places which is equipped with 
practically every known facility for the 
study of the causes which underlie insan- 
ity and mental illness. So little is known 
of these disorders that such an institution 
occupies a position of even international 
importance. 
WOMAN’S CLINIC 

Little more than a year ago a fourth clin- 
ical institute, the Woman’s Clinic, was 
established through the gift of Mrs. Lucy 
Wortham James. From the standpoint of 


WHAT ITIS 9 


the number of patients treated it ap- 
proaches the general hospital, for 3,522 
women were cared for in its rooms and 
wards last year. It is also the first and 
only modern obstetrical clinic in America 
to be established as a full-time depart- 
ment of both a hospital and a medical 
school. 


THE WILMER CLINIC 


Within the coming year there is to be es- 
tablished as part of the Johns Hopkins 
Hospital and the Johns Hopkins Medical 
School a fifth clinical institute. This will 
be the Wilmer Clinic for the study and 
treatment of diseases of the eye and in- 
vestigation of the causes of blindness. It 
will be under the direction of Dr. William 
Holland Wilmer of Washington, D. C. In 
all $3,000,000 has been contributed for 
this project. 


COORDINATE STRENGTH 


There are few hospitals in existence which 
have the counterpart of any one of these 
five clinical institutes. No other American 
hospital combines their equivalent in a 
single group. The Wilmer Institute, for 
instance, will be unique in that no like 
project has been attempted hitherto in 
this country, which for the most part has 
had to depend on Europe for the bulk of 
advanced research regarding diseases of 
the eye and for the training of its leading 
ophthalmologists. 


Disease does not attack one part of the 
body and leave the other parts function- 
ing normally. Diseases of the eye are often 
closely related to diseases of the brain; 
diseases of the bones to diseases of the 
blood; diseases of the skin to diseases of 
the internal organs; remote infections may 
result in serious and even fatal diseases of 
the heart. 


INTERRELATION OF DISEASE 


Throughout the whole field of human ail- 
ments the problems are so interrelated 
that one disease or one group of diseases 
can seldom be understood and treated to 
the best advantage without a thorough 
knowledge of other diseases or disorders 
which are related to the specific trouble 
under observation. The men who special- 
ize in one field find that their work is gen- 
erally much more effective if they can ob- 
tain aid from men who are specializing in 
other fields. That is the reason why each 
service of the Johns Hopkins Hospital 
and each of its clinical institutes gains 
strength through its association with the 
other departments of the unified group. 
None could be so useful and effective if it 
stood alone. 

Because of these facts the Johns Hop- 
kins Hospital has extended its services in 
an effort to compass, as nearly as possible, 
the entire range of medical and surgical 
ailments which afflict those who come to 
it for aid. 


mi. RELATION TO THE MEDICAL SCHOOL 


If disease were an open book, if it were mation concerning its problems. But, al- 


thoroughly understood, hospitals would 
be in no further need of additional infor- 


though the last fifty years have seen 


greater medical progress than all the pre- 


10 THE JOHNS HOPKINS HOSPITAL 


ceding years of history, the physicians 
and surgeons of a hospital find that all 
they know now does not begin to provide 
them with the knowledge which they need. 


A TEACHING HOSPITAL 


Therefore it is a matter of prime impor- 
tance to remember that the Johns Hop- 
kins Hospital is a teaching hospital—a 
hospital where men try not only to apply 


what is already known, but also seek to = 
discover better and more effective meth- * 


ods for the conquest of disease, where such 
methods are not only applied to the relief 
of patients within the hospital but also 
serve to teach the physicians and the sur- 
geons of the future. It was the first hospi- 
tal in this country which was founded pri- 
marily with the idea that it should be- 
come a partof a medical school and should 
make the advancement of medical knowl- 
edge one of its major endeavors rather 
than a subsidiary activity. 


BENEFICIAL RESULTS 


The resulting benefits are twofold: first, 
the patients of the hospital receive the full 
benefit of the latest medical knowledge 
and the discoveries which result from re- 
search in the Medical School; second, the 
Medical School has the opportunity to 
study disease as a living problem rather 
than as a dead language or something 
which is dealt with merely in books and 
lectures. 


FACULTY AND STAFF ARE ONE 


The value of such cooperation between a 
hospital and a medical school is evident. 
The problem, however, has been to make 





THE HARRIET LANE HOME 


it effective. That an effective method was 
found at Johns Hopkins has been evi- 
denced by the fact that its system has 
been followed by many of the leading hos- 
pitals of the country, particularly those 
which are associated with Class A medical 
schools. The union between the two insti- 
tutions was brought about by making the 
staff of the Hospital and the faculty of the 
Medical School one body. 


“THE FOUR DOCTORS” 


The late Sir William Osler was the Physi- 
cian-in-Chief of the Hospital and the first 
Professor of Medicine in the Medical 
School. Dr. William S. Halsted was the 
first Surgeon-in-Chief of the Hospital and 
Professor of Surgery in the Medical 
School; Dr. Howard A. Kelly was the first 
Gynecologist-in-Chief and Professor of 
Gynecology, and Dr. William H. Welch, 
who organized the Hospital’s Department 
of Pathology, was also the first Professor 
of Pathology in the Medical School. 


We ESAS ITA TS, II 





BEST FOR THE PATIENT 


Ever since that time the junior members 
of the staff, as well as the chiefs of ser- 
vices, have also been members of the Med- 
ical Faculty. This insures to patients the 
best of medical attention, for these men 
bring to the treatment of disease the lat- 
est and most effective medical knowledge. 
As teachers, they must give the reasons 
for the things they do, and hence their 
knowledge must be of the soundest type. 
Under such a system fallacies are open to 
immediate detection. 


RESEARCH AND MEDICAL PROGRESS 


Engaged as it is with the Medical School 
in an educational project, the Hospital is 
seeking to advance medical knowledge. 
Thus the members of its staff are always 
endeavoring to discover better methods 
by which to combat disease. Although the 
Hospital has many laboratories of its own, 
which are in constant use for the chemical, 
physical and bacteriological tests neces- 
sary to the every-day diagnosis, the mem- 
bers of its staff are able to go much further 
in the study of the underlying causes of 
disease because of the laboratory facilities 


provided by the Medical School. 


COOPERATIVE EFFORT 


The staff of the Johns Hopkins Hospital, 
for instance, has played a leading role in 
discovering the underlying cause of rickets 
and dependable measures for the preven- 
tion and cure of this disease. This could 
hardly have been accomplished without 
the laboratories of the Johns Hopkins 
Medical School and the Johns Hopkins 
School of Hygiene and Public Health, or 


without the aid of men on the faculties of 
these schools. 


RELATION TO THE SCHOOL OF HYGIENE 


Hospital patients are always the victims 
of disease, but the ideal hospital should 
endeavor not only to cure them but to 
keep them well. It is therefore of particu- 
lar advantage that the Johns Hopkins 
Hospital is closely associated with the 
School of Hygiene and Public Health. 
This school is concerned primarily with 
the discovery of methods for the preven- 
tion of disease. It is regarded as one of the 
leading centers for this new medical sci- 
ence, and its students, mostly trained 
medical men, come to it from every con- 
tinent. This school has been housed at a 
considerable distance from the Hospital, 
but its new building is being erected as 
part of the main medical group. 


AIDED BY THE UNIVERSITY 


The problems of combating disease, to a 
great extent, concern the application to 
the functions of the living body of the 
basic knowledge of such sciences as Chem- 
istry, Physics, Biology and Psychology. 
The departments of the Johns Hopkins 
University naturally are able to make a 
more extensive study of these sciences 
than are the Medical School and the 
School of Hygiene. Hence, the scientific 
faculties of the University are able to pro- 
vide the staff of the Hospital with special 
aid and counsel which is often of the ut- 
most importance. For example, the test 
which is now used in the Hospital to de- 
termine whether or not a patient’s kid- 
neys are in condition to withstand the 


12 THE JOHNS HOPKINS HOSPITAL 


shock of an operation—a test which has 
saved many lives—is made with a sub- 
stance discovered in the University’s De- 
partment of Chemistry. 


THE SUM 


The general medical and surgical services 
of the Johns Hopkins Hospital, plus its 
five clinical institutes, plus the Johns 
Hopkins Medical School, plus the Johns 
Hopkins School of Hygiene and Public 
Health, plus the scientific departments of 
the Johns Hopkins University, sum up the 
scope of a medical group which offers in- 


deed a mighty bulwark against disease. It 
also represents a foundation established 
by thirty-six years of outstanding fruitful 
endeavor and a physical plant which to- 
day would cost many millions of dollars to 
duplicate. 

On the basis of what already exists at 
Johns Hopkins this country now has the 
opportunity to develop for itself, within 
a relatively short time, a medical center 
such as may well equal if not surpass any- 
thing which existed in Europe even prior 
to the war or is likely to exist there for 
many years to come. 


PART. TWO 


THE JOHNS HOPKINS HOSPITAL 
WHAT IT DOES 


7 


= =, LD THOUGH patients come to the Johns Hopkins 


| 


| in promoting the conquest of disease goes far be- 







Hospital from all parts of the country, its influence 


yond the range of the persons who receive direct 
=) benefit from treatment within the institution itself. 
The Hospital, as a center of medical education, is able not only to 
give its own patients much better care than would otherwise be 
possible, but is also able to benefit thousands of persons who will 


never see the Hospital itself. 


1.§ ADVANCING MEDICAL KNOWLEDGE 


There are now 1,936 Doctors of Medi- 
cine, graduates of the Johns Hopkins 
Medical School, who were trained in the 
Johns Hopkins Hospital. They are caring 
for the sick, preventing disease, and car- 
rying on medical research in every state 
and territory of the United States and in 
fifteen foreign countries. 

The graduates and former members of 
the Johns Hopkins medical staff, more- 
over, include 121 men who now hold full 
professorships in forty-two American and 
nine foreign medical schools. As the Johns 
Hopkins method of coordinating the work 
of medical education with that of hospital 
treatment has been adopted generally 


throughout the country, the majority of 
these men are also members of the staffs 
of important hospitals where teaching is 
coordinated with care of the sick. 


RESEARCH LEADERS AND CLINICIANS 


On the staff of the Rockefeller Institute 
for Medical Research Johns Hopkins men 
outnumber those from any other medical 
institution. The directors of both the in- 
stitute and its hospital are former mem- 
bers of the staff of the Johns Hopkins 
Hospital. Johns Hopkins men also occupy 
such positions as Surgeon-in-Chief, Physi- 
cian-in-Chief, Obstetrician-in-Chief and 
Physician-in-Charge of the Neuropsychi- 


14 THE JOHNS HOPKINS HOSPITAL 





atric Division, at the new Henry Ford 
Hospital in Detroit. 


TRAINING HOSPITAL EXECUTIVES 


Many of the directors of well-known hos- 
pitals also received their early training at 
Johns Hopkins. These include the direc- 
tors of the hospitals of the Universities 
of Chicago, Maryland and Georgia; the 
Cornell Clinic, New York City; the 
Barnes Hospital, St. Louis; the Charles 
T. Miller Hospital, St. Paul, and the 
Hartford Hospital, Hartford, Conn. One 
of Great Britain’s foremost institutions 
for the treatment of mental diseases, the 
Royal Mental Hospital of Glasgow, is 
also under the direction of a former mem- 


ber of the Johns Hopkins staff. 


POSTGRADUATE INSTRUCTION 


During several months of the year the 
Hospital also offers postgraduate instruc- 
tion to practising physicians and surgeons, 
who come to attend clinics or serve for a 
period on the staff of some department. In 
recent years medical progress has been so 
rapid that many men in general practice 
are eager to avail themselves of such op- 
portunities. Their patients, though they 
may never receive care at the Johns Hop- 
kins Hospital, benefit through this work. 


TRAINING OF DIETICIANS 


Food is an important factor in the treat- 
ment of disease in the cases of under- 
nourishment among children and in many 
other conditions where diet is all impor- 
tant. In view of this fact, a department 
was established in the Hospital to make a 
special study of nutritional problems in- 





A CUBICLE IN THE WOMAN’S CLINIC 


volved in the care of various patients, and 
at the present time asix-months’ course in 
hospital dietetics is provided. An average 
of ten graduate dieticians, chiefly from 
other hospitals or universities are study- 
ing this work at Johns Hopkins through- 
out the year. 


TRAINING OF NURSES 


The School for Nurses is the principal ed- 
ucational branch of the Hospital as dis- 
tinct from the University. This school was 
founded with the opening of the Hospital 
in 1889 and in its own field of medical ed- 
ucation has been a leader in establishing 
higher standards. 

It was the first: 


1 To put instruction ahead of routine work in 
the training of nurses. 

2 To abolish pay for nurses in training, thus 
putting them on a student rather than an 
employe basis. 


3 To establish an eight-hour day, thus provid- 
ing student nurses more ample time for study. 


4 To establish laboratory courses for nurses. 
5 To establish a three-year nursing course. 


6 To employ regular paid instructors to conduct 
the courses for nurses. 


WHAT IT DOES 15 





Its alumni number 1,260 and among 
them are a large number of women who 
hold or have held the most important po- 
sitions in the field of nursing throughout 


the world. They include: 


Director of the Department of Nursing and 
Health, Teachers College, Columbia Univer- 
sity. 

Professor of Nursing, University of Michigan. 

Director, Department of Nursing, American 


Red Cross. 

Chief, Department of Nursing, League of Red 
Cross Societies, Switzerland. 

President, American Nurses Association. 

President, National League of Nursing Educa- 
tion. 


Superintendent of Nurses, Union Medical Col- 
lege and Hospital, Peking, China. 


The School for Nurses and the Depart- 
ment of Nursing of the Hospital are uni- 
fied under the same control. The School, 


therefore, not only trains nurses for ser- 
vice in other hospitals, in homes, in pub- 
lic health work and in industrial services, 
but also insures that the Hospital itself is 
provided with a corps of nurses who are 
competent to care for its patients. 


WIDE INFLUENCE OF HOSPITAL TRAINING 


Thus, through the men whose medical 
education was received in the Johns Hop- 
kins Medical School and the Hospital, 
through the men who have received train- 
ing in the Hospital as members of the 
staff or as postgraduates, and through the 
work of nurses and dieticians trained in 
the Hospital, the benefits derived from 
this institution are carried throughout the 
country and to distant parts of the world. 


u. THE STAFF 


No matter how extensive the buildings, 
how complete the organization and the 
departmental services of a hospital, these 
things in themselves cannot establish an 
institution of the first rank. After all they 
are details—means to an end. The end is 
accomplished through them, but the ac- 
complishment itself lies in the work of 
men—the men and women who make up 
the staff and personnel of the Hospital. 

At the present time the personnel of the 
Johns Hopkins Hospital, including the 
Dispensary, is as follows: 





Resident Physicians... a. 220-24: ais 
Visiting: Pysicians:\.. 22. rece 189 
Officers and Head Nurses......... op? 
Stident Nurses oh. s2 t vee aes 250 
Bayi timploveseces: ss 23 dakeaee 752 

1338 


In keeping with the original direction of 
the founder, the staff of the Johns Hop- 
kins has been always fortunate in having 
“surgeons and physicians of the highest 
character and greatest skill.” 


MORALE 


Its reputation has not been established 
alone by the outstanding men who head the 
various departments. These men have been 
assisted by a large body of younger men 
of marked ability, and the efforts of the 
entire staff have always been marked by a 
spirit, a morale, which has fused theaccom- 
plishments of individuals into the greater 
and common record of the Hospital. 

The members of the Johns Hopkins 
staff are willing to put pride in the ac- 
complishments of the Hospital as a whole 


16 THE JOHNS HOPKINS HOSPITAL 


before pride in individual accomplishment. 
The result is found in the widespread 
faith of the public in the Hospital as a 
whole; in the fact that hundreds of pa- 
tients come to Johns Hopkins every year, 


firm in the belief that they will receive the 
best of treatment, and yet without the 
remotest idea as to the identity of the in- 
dividual physicians and surgeons who will 
attend them. 


ul. THE PATIENTS 


There is no arbitrary standard by which 
the ability of a hospital staff can be judged 
but one of the best tests is whether its pa- 
tients come not only from the immediate 
community but also from distant points. 


WHERE THEY COME FROM 


From January Ist to December 31st, in- 
clusive, 1924, there were 3,310 bed pa- 
tients who came to the Johns Hopkins 
Hospital from homes outside of Balti- 
more. This was 33 per cent. of the total 
number for the year. Their residential 
distribution was as follows: 


Maryland putes Peer koe 997 
West Virginia. . 381 
Peéennsylvania.2)..14.4 Pas eee 273 
ViTgini anti hi we eae 246 
North Carolina: s\n uniee eacasiols 240 
DROW LODK coy Syl er AeA ern te 185 
District of Columbiavin nanan 128 
SoutniCarolina 9. i) \e waits ee IOI 
NCHNESSER 2 ob sa. earcie on eeee Sn 99 
Flondan sii i.e io cee See 94 
EOP Se rae ol ak 73 
New Jersey! icici k eae ee 65 
US WN eg EOE PL SN 44 
Gebietes grica te: sateen se 43 
Delaware? 253)... 4 i ee 35 
Kenpeckviies ok... 5.0): ae eee 34 
Alabatigiaetes. cece cn wake 22 
Connegtienty...(.. . ASS aan eae 23 
Thins mies Fe...!s 1 UA 2 ae 21 
Okla@ere eis... 4 tele een ski 21 
Other States East of Mississippi... 64 
Other States West of Mississippi... 67 
Residents of Foreign Countries.... 44 





These patients included residents of 
forty-three states, the District of Colum- 
bia, the Panama Canal Zone, and ten 
foreign countries. 


REPRESENTATIVE OF ALL CONDITIONS 


The diseases from which these persons 
suffered were as diverse as their geographic 
distribution and the patients themselves 
ran the gamut of race, color, creed and 
condition. As an illustration, among those 
cared for at Johns Hopkins during the 
last few months were: 

A former member of the Cabinet whose home 
was in California. 

A negro who came to the Hospital by “riding 
the rods” of a freight train from North Caro- 
lina. 

Wealthy residents of New York, Detroit, 
Chicago, Denver and San Francisco. 

The blind children of a West Virginia moun- 
taineer, whose entire savings for two years 


were barely sufficient to pay their fare to 
Baltimore. 


THE WIDEST DISTRIBUTION 


Although the majority of the patients at 
the Johns Hopkins Hospital are unable to 
pay the full cost of their treatment and 
care, it is among those who can do so and 
find the cost of travel no impediment, that 
the widest geographic distribution is 
found. A survey, representative of an 
average day in the Hospital, showed that 
81.5 per cent. of the private patients came 


WT ATER ESD OF S 


from homes outside Baltimore. Their resi- 
dential distribution was as follows: 


UNIS iia le ONE a Ra a ut 
LESTE AN Sec Me Res Ue Ne II 


reste Vitis? Pre Mon ees cos, el, 
AONE 0 A er 


9 

7 

6 

5 

4 

4 

I 3 
TE at he ll BR OF 3 
PepeEeTROuaATONN A 9. Madhu hk asin . 
EES Sole Ra BU oa oy SE 
2 

2 

2 

2 

2 

2 

2 

I 

I 

I 

I 

I 

I 


ROMA ATG AH alk: s http ites! Li ib 
OME Tan 8 SE TE ey BO oem NOR 
CIN GAI nares let oe rie, Cte see 
MIE WRPEESCY 6 iota es ee ta sb 
Bra niia me one eka oboe 
LF 015g Va Pate OSU Mag Ta aa ee 
meagan eee bee ce, woe eke 
"Hesse aN ott A ik A, 

OSCE ey Bo 2a nae 
PVLEIECO Maye. Sta Se Fo honcien 3 ate 


1924 A RECORD YEAR 


In 1923 the Hospital cared for 8,549 pa- 
tients. This total was greater than that for 
any previous year in its history. But in 
1924, that is, the year ending January 31, 
1925, it exceeded this record by 1,622. 
The total number of bed patients cared 


YEARLY INCREASE IN NUMBER OF PATIENTS 1890-1925 





17 


DISTRIBUTION OF PATIENTS 
Year Ending Fanuary 31, 1925 


Days 
Treatment 


26,917 
14,528 
11,492 
24,563 


77,590 


GENERAL HospPITaL 
Private 
Ward Rate 
Less than Ward Rate... . 
Free Patients 


Patients 
1,370 
875 
719 
1,330 


4,294 


EAC EL 3 7G) 
1,602 
6,638 


19,808 


Less than Ward Rate... . 
Free Patients 


29,418 
Puipps PsycutaTric CLINIC 
Private 
Ward: Ratesn seer 
Less than Ward Rate... . 
Free Patients........... 


9,248 
8,336 
5,099 
3,831 
26,514 
Brapy Uro.ocicat INSTITUTE 

Private 

Ward Rate 

Less than Ward Rate... . 
Free Patients 


11,969 
2,652 
670 
1,497 


16,788 

Woman’s Ciinic 
Private 1,084 
621 
g,012 
12,956 
235933 


47,606 


Ward Rate 
Less than Ward Rate... . 
Pree: Patientsosias. eee 


Totals 10,171 197,826 





for during the year that has just come to 
a close was 10,171. 

The daily average of bed patients for 
the year was 542. The average weekday 
total of Dispensary patients was 579. 
This means that on every regular week- 
day throughout 1924 the Johns Hopkins 
Hospital treated an average of 1,127 sick 
persons. More patients are constantly 
seeking aid than can be cared for, but the 


18 THE JOHNS HOPKINS HOSPITAL 





Hospital is constantly striving to give lished when a total of 1,558 bed and dis- 


treatment to all who come to it. On Feb- 
ruary 24th, 1925, a new record was estab- 


pensary patients received treatment on — 
that day alone. 


Iv. FREE CARE 


There has somehow arisen a widespread 
impression that a very large proportion of 
the patients who come to the Johns Hop- 
kins Hospital are persons of wealth. This is 
not true. The facts are that for every bed 
patient who comes to Johns Hopkins and is 
able to pay the full cost of his treatment, 
four are cared for who are unable to do so; 
that for every patient who pays the full 
cost there are two patients who are unable 
to pay anything. 

The following is the total of bed pa- 
tients cared for in the Johns Hopkins 
Hospital from February 1, 1924, to Jan- 
uary 31, 1925: 








Number Total Days 
Patients Treatment 
Private Patients... 20... 2,120 50,588 
Semi-Private Patients. . . 51 621 
Ward Rate Patients.... . 1,714 36,130 
Less than Ward Rate.... 2,054 36,855 
rec Patients yee sone pease se 73,032 
LP otalscne sabia 10,171) 197,826 


FORTY-SIX PER CENT. PAY NOTHING 


Of these patients only 21.3 per cent. paid 
the full cost of their treatment. In all 
78.7 per cent. were cared for at less than 
cost and 41.6 per cent. of the total were 
cared for absolutely without charge. The 
fact that 5 per cent. more who intend to 
pay prove to be unable to do so, brings the 
total of wholly free patients to 46.6 per 
cent. of the total. 





78.7% AT LESS THAN COST 


Although 78.7 per cent. of the patients at 
Johns Hopkins are cared for at less than 
cost, they are not, in general, habitually 
dependent. They are rather to be regarded 
in the light of persons who are the victims 
of catastrophe such as a fire, an earth- 
quake, or a war. 


WHEN DISEASE STRIKES 


Many an industrious workman, who is 
well able to provide for himself and his 
family under ordinary conditions, is un- 
able to bear any of the cost of hospital 
treatment when he becomes acutely ill. 
Even though he has been thrifty and has 


accumulated savings, these are often only 


WHAT IT DOES 19 





enough to guard his family against priva- 
tion while he is unable to work. 


COST EXCEEDS $500,000 A YEAR 


At any rate such a patient is admitted to 
the wards regardless of his ability to pay. 
The ward rate is $2.50 a day, approxi- 
mately half the cost per capita to the 
Hospital for each patient, which is $5.08. 
Only approximately one-fourth of the 
ward patients, who constitute four-fifths 
of all the bed patients in the Hospital, are 
able to pay the full ward rate. Less than 
one-fourth are able to pay some amount 
less than the ward rate. More than one- 
half of the ward patients pay nothing at 
all. In all the Hospital spent more than 
half a million dollars on free care last year. 


ALL PATIENTS TREATED ALIKE 


These patients who pay nothing or less 
than cost nevertheless receive the same 
expert treatment and care that wealthy 
persons seek to obtain by paying the reg- 
ular private rate of seven to thirteen dol- 
lars a day, plus fees for treatment, and 
often the cost and time involved in com- 


ing to Johns Hopkins from a great dis- 
tance. 

In the main it may be said that the 
ward patients receive exactly the same 
treatment as the private patients with the 
exception of not having a private room to 
themselves. Many members of the staff 
attend both private and the free patients; 
the same laboratories and facilities for 
diagnosis and treatment are available for 
both. All patients are admitted to the 
Hospital on the basis of but one considera- 
tion: the degree of their need for medical 
and surgical attention. Ability to pay is 
not a determining factor either in receiving 
or caring for patients in the wards. 


CARE OF COLORED PATIENTS 


In this connection it is important to note 
that 2063 of the Hospital’s bed patients 
last year, approximately one-fifth of the 
total, were colored people. In many dis- 
tricts throughout the South there are no 
local facilities whereby colored people can 
obtain the best of medical and surgical 
attention, and from there many indigent 
patients turn to Johns Hopkins for aid. 


v. THE DISPENSARY 


The patients who are so acutely ill that 
they must be cared for in the wards of a 
hospital are but a small proportion of 
those who need medical aid. Each day, 
for every patient who receives bed care 
in the Johns Hopkins Hospital, there is 
another who is treated in the Hospital’s 
Dispensary. In all, approximately 3,127,- 
711 visits have been made to this depart- 
ment. In the year ending January 31, 


1925, alone, the number of dispensary 
visits was 176,631. 


FREE CARE 


Many of these patients would have be- 
come bed patients had it not been for the 
treatment received while they were able 
to be up and about. The suffering and the 
economic waste prevented by this service 
cannot be estimated. Most of those who 


20 THE JOHNS HOPKINS HOSPITAL 


SSE anaepaed sey 


B 






AFM FESSTEE 4h ME ot OEE 


Dray erceg ta a 


wee sat Aig PPR OS pagar oc gay fr 






CSTOURBE el OE 2 
















THE NEW DISPENSARY 
(To be opened in 1926) 


avail themselves of it would suffer intense- 
ly if sickness destroyed their earning 
capacity even for a short while. This is 
shown by the fact that the average return 
in fees to the Hospital for each visit of a 
Dispensary patient is but nine cents. The 
cost of operating the Dispensary is a large 
item in the total of the $500,000 a year 
whieh the Hospital expends on free care. 


SCOPE OF THE WORK 


To a large extent the same staff which at- 
tends the private patients cares for the 
Dispensary patients. Every facility at the 
command of the Hospital for diagnosis 
and treatment is used for their benefit. 
The wide scope of this service is illustrated 
by the following table of medical and sur- 
gical classifications of the Dispensary pa- 
tients treated during one year. 


DISTRIBUTION OF DISPENSARY PATIENTS 


YEAR 1924 

Medicine: /vis- iene ae eee 10,982 
Gastro-Intestinal............. 9,932 
Metabolism.) Jos aine ee 2,196 
Tuberculosis, :<:\.40). 5.2 a ee 
Nenrology{ sac) ie eee 3,692 
SUPRELY sa pic wide sae eles ae 26,302 
Genito-Urinary...4 4; 003 II,915 
Orthopedicssai) gare cae noe 13,531 
Ear, Nose and Throat........ 11,095 
Diseases of the Eye.......... 7,980 
Skin. re; 22 Suen, sae 4,847 
Gynecology :):. Gatien eo 95323 
Obstetrics...) \Su near, ce 7.038 
Dentistry. i cts ee ee 2,030 
Syphilis: |: eee pee. 19,031 
XRay lon Soap te ts fog 11,185 
Children’s Diseases........... 18,232 
Psychiatry senna © ke Are 2,522 

TOtalguerraw can sea cree 176,631 


WOH AER ED OES 21 


Such brief classifications, however, do 
not always speak so eloquently as the fact 
than more than half of the crippled chil- 
dren of Baltimore alone have, at one time 
or another, received aid from the ortho- 
pedic service of the Dispensary. Most 
Dispensary patients have very little 
money but many of them contrive to 
come to the Dispensary from a distance. 
One family spent the accumulated sav- 
ings of two years in paying the carfare 
of two children whose sight was restored 
through free treatment. 


THE CARNEGIE GIFT 


Remarkable as the record of the Dispen- 
sary has been, its work nevertheless has 
been hampered and curtailed by lack of 
money and space, both in the treatment 
of patients and in the teaching of students. 
The Carnegie Corporation, however, con- 
sidering that the curtailment of this work 
would be a great misfortune, has given 
$1,000,000 for the erection of a new dis- 
pensary building and $1,000,000 for the 
endowment of the work. 


vi. SOCIAL SERVICE 


Attention has been called to the fact that 
the Johns Hopkins Hospital attempts not 
only to enable people to regain their 
health but also endeavors to teach and 
aid them to retain it when once regained. 
To this end it established its Social Ser- 
vice Department, one of the first hospital 
agencies of this kind. The workers in this 
department not only assist the medical 
staff in furnishing patients with such in- 
struction as is needed best to insure con- 
tinued health, but also strive to combat 
those influences which, though not pri- 
marily medical and surgical problems, 
have a most important bearing on the 
recovery and subsequent health of the 
patient. 


THE PROBLEM 


Before this work was begun patients not 
infrequently came to the Hospital for 
treatment, were discharged as cured and 
then returned within a short time suffering 
with the same ailment. Sometimes this 
would occur repeatedly within a few 
months. The results were disappointing— 


waste in the health of patients, waste of 
the time of the physicians, and in the cost 
of treatment. 


THE SOLUTION 


By giving special attention to aiding pa- 
tients in establishing habits of life which 
are conducive to health, obtaining em- 
ployment such as is not detrimental to 
them as individuals, and in improving the 
hygienic surroundings of daily life, the 
Social Service Department has done much 
to overcome the cases of recurring ail- 
ments. A large part of its work, however, 
has to do with the patient while he or she 
is still in the Hospital. Recovery often can 
be materially hastened by the removal of 
worries which interfere with a patient’s 
normal recuperation. 

Sometimes a mother is worrying because 
she fears her children are being neglected 
in her absence, or a father does not get 
well because he is afraid he will lose his 
job while he is in the Hospital. When such 


fears are put to rest, the effect on the re- 


ed THE JOHNS HOPKINS HOSPITAL 


covery of the patient is often remarkable. 

This department also endeavors, when- 
ever possible, to bring all members of a 
family to the Hospital for examination, 
when one of their number is found to be 


suffering from a communicable disease. In 
this manner the contact of a single person 
with the Hospital often results in an en- 
tire home being freed from disease. 


vu. IDEALS 


Money, building, equipment, able ad- 
ministrators and able staff are not alone 
sufficient to make a hospital all that it 
should be. A hospital is a human institu- 
tion, not a machine. For that reason it 
must have certain aims and ideals by 
which to guide its course. The first object 
of the Johns Hopkins Hospital is, as far 
as possible, to give the patient the most 
effective treatment and care. Its activi- 
ties as a center of medical education exist 
primarily in the interest of the patient. 
Thus, the attitude of the Hospital toward 
the patient is the criterion of its policy. 
This attitude is summarized in the follow- 
ing code: 
THE CODE 


(All patients are admitted without regard 
to creed, color, race, social condition, 
or ability to pay. 

@All patients are admitted solely on the 
basis of their need for medical and sur- 
gical attention. 


@ All patients are to receive equal considera- 
tion and care. 

(All patients are to receive the full benefit 
of scientific investigation seeking better 
methods to combat disease. 

@All patients are to be regarded as indi- 
vidual problems rather than general 
“cases.” 

All patients are to receive not only skillful 
medical and surgical attention, but con- 
siderate treatment as human beings as 
well, 

@LAll patients are to receive any aid the 
Hospital can give, in addition to hos- 
pital care, which will promote their 
recovery. 

@All patients are to be given any instruc- 
tion or information which will help 
them to stay well after they have left the 
Hospital. 

@ All patients are to be treated fairly in re- 
gard to fees, no matter whether they are 
able to pay much, little or nothing at all. 


vil. THE FRUITS OF RESEARCH 


In surveying the scope of the work that 
goes on within the Johns Hopkins Hospi- 
tal there is danger of thinking of its use- 
fulness only to the persons primarily in- 
volved, the patients in the beds and the pa- 
tients who come to the Dispensary for 
treatment. It must always be remembered 


however, that the research and _ skill 
brought to bear in the constant effort to 
provide better means and methods for the 
treatment of these immediate patients 
have resulted in great advances which 
have been of benefit to patients in all parts 
of this country and in foreign lands as well. 


TE SIRURURE 23 


To recount even a general summary of 
representative Johns Hopkins contribu- 
tions to the advance of medical knowledge 
requires a pamphlet by itself, such as was 
recently published by the Half-Century 
Committee under the title: “The Spirit 
of Inquiry in Medical Education.” It 
would not be fitting, however, to pass by 
this subject without some word concern- 
ing the part which present and former 
members of the staff of the Johns Hop- 
kins Hospital have played in the estab- 
lishment of modern methods in Medicine 


and Surgery. 
IN SURGERY 


In Surgery the substitution of skillful dis- 
section for blunt tearing; the practice of 
the gentle handling of tissue to avoid 
trauma and of leaving no dead tissue be- 
hind; the present operative methods in 
cases of intestinal diseases, hernia, cancer 
of the breast, goitre, gall-bladder surgery, 
blood vessel surgery, brain surgery and 
gynecological surgery, all are standards 
and methods which, as now followed in 
' this country, owe much to the past and 
present members of the Johns Hopkins 
staff. 


IN MEDICINE 


In Medicine the same is true. The fact 
that the underlying causes of disease 
can be discovered and finally overcome 
by exhaustive research involving a deep 


knowledge of the chemical and physical 
reactions of the body and of the activities 
of bacteria, has been demonstrated re- 
peatedly by the work at Johns Hopkins. 
Here it was shown that the laboratory 
provided a most practical means for ap- 
plying the knowledge of the exact sci- 
ences to the specific problems of the in- 
dividual in the hospital bed. 

The diagnosis of typhoid fever by blood 
culture, the isolation of the paratyphoid 
bacillus, the first important studies in this 
country of amoebic dysentery, the dis- 
covery of the cause of tetany, the discov- 
ery of the Welch Bacillus, the gas-produc- 
ing organism which was a common cause 
of “gas gangrene” in the wounds of sol- 
diers, are typical products of the work in 
the departments of Medicine and Pathol- 
ogy in the Johns Hopkins Hospital. 


HOSPITAL PUBLICATIONS 


Every laboratory research and every ob- 
servation of disease at Johns Hopkins 
Hospital, wherein something is discovered 
which will be of benefit to others in pro- 
tecting against or combating disease, is 
published. The Hospital and University 
maintain two periodicals for this purpose. 
They are the Bulletin of the Fohns Hopkins 
Hospital and the Fohns Hopkins Hospital 
Reports. The scientific medical papers 
printed in this manner give to the entire 
world the benefits of discoveries made in 


the Johns Hopkins Hospital. 


PART THREE 


THE JOHNS HOPKINS HOSPITAL 
ITS FUTURE 


ml 


| 





7 


MAN institutions, no matter how distinctive their 
| past record, do not maintain the same level of 
| achievement. They either retrogress or go forward. 
| It is the intention of the Johns Hopkins Hospital 


| to go forward. When an army moves forward it con- 


solidates the gains already made, as well as marking out new objec- 


tives. These two characteristics pervade the plans which the Hos- 


pital is laying for the future. 


In the early part of this presentation it 
was pointed out that one of the chief dis- 
tinctions of the Johns Hopkins Hospital 
was the fact that it now has, in addition 
to the general medical and surgical ser- 
vices, five great clinical institutes, each 
one of which is a special hospital and 


research center in itself. These, with the 
general medical and surgical services of the 
Hospital represent the units established 
in an encircling movement now under way 
at Johns Hopkins to completely invest 
and lay siege to the entire province of 
disease. 


1. DISEASES OF CHILDREN 


At the present time one of these units is 
threatened financially. This is the Harriet 
Lane Home for Children, the institute 
which is devoted to the study and treat- 
ment of the acute diseases of infancy and 
childhood. One-third of the income now 
used to support its work is derived, under 
temporary permission, from $1,000,000 of 


a fund contributed by the General Edu- 


cation Board for the general development 
program of both the Medical School and 
the Hospital. This money must soon be 
expended according to the terms of thegift. 


A TRAGIC CRISIS 


Unless the Hospital obtains $1,000,000 to 
replace this sum, it will be faced by the 
tragic alternative of closing one-third of 


Pee LR 25 


the beds now devoted to the medical care 
of children or of abandoning free care in 
this department. The adequate financing 


of this work is the most immediate need 
of the Hospital program. 


u. MEDICINE AND SURGERY 


The next step in rounding out the group 
of clinics is the enlargement of the facil- 
ities for general medicine and surgery. 
Present facilities are entirely inadequate, 
but opportunity for equal progress in all 
other branches of Medicine and Surgery 
can be provided for at Johns Hopkins by 
the reconstruction, enlargement and en- 
dowment of its present medical and sur- 
gical clinics. The Medical School, for in- 
stance, is seeking $500,000 each for de- 
velopment in the following fields: ortho- 
pedic surgery, diseases of the ear, nose 
and throat, and diseases of the skin. At 
present the Hospital has very few beds 
for the treatment of diseases in these 
fields, but the reconstruction of the med- 
ical and the surgical wards would over- 
come this deficiency. 


THE TRUNK OF THE TREE 


The special clinics and institutes of the 
Hospital contribute greatly to its general 
strength and effectiveness but the very 
foundation of the Hospital’s work is its 
general medical and surgical wards. Of 
the 683 beds of the Johns Hopkins Hos- 
pital only approximately one-fourth are 
devoted to general Medicine and Surgery. 
The Hospital is now like a tree which has 
branched out fruitfully without a corre- 
sponding growth of the trunk. This is due 
to the fact that it has not received money 
for the reconstruction and enlargement of 
its general wards. 


There are ninety-two beds in the medi- 
cal clinic and ninety-three beds in the sur- 
gical clinic. Both are confined to cramped 
quarters in the identical structures which 
they occupied when the Hospital was 
opened in 1889. The lack of better oppor- 
tunities to study general Medicine and 


Surgery is also hampering the progress of 
the Medical School. 


THE SUPREME REASON 


But the one supreme and compelling rea- 
son which calls for the reconstruction and 
expansion of the medical and surgical 
clinics is the fact that hundreds of patients 
in excess of the number that can be ac- 
commodated, particularly from the East 
and South, are applying to the Hospital 
each year for treatment. 

There are, for instance, only ten beds 
for the surgical care of children and only 
ten beds for contagious diseases of 
adults. The arrangement of the old wards 
is not such as to provide for the most ef- 
fective and economical grouping of pa- 
tients according to their diseases and, 
with the progress of medical science, this 
will become an increasing handicap un- 
less remedied. 

As they stand now, the old wards can 
be reconstructed so that each new clinic 
can accommodate from 150 to 200 pa- 
tients. The cost in each instance will not 
be more than $650,000, which is consider- 
ably less than would be required for erect- 


26 THE JOHNS HOPKINS HOSPITAL 


BLOCK PLAN 


JOHNS HOPKINS 
HOSPITALS 
MEDICAL SCHOOL 


Hospitat Buitpincs 
1 Administration Building 
2 Administration Annex 
3 Students Rest Room 
4 Marburg Private Wards 
5 Staff Dining Room 
6 Service Bldg., Kitchen, etc. 
7 Brady Urological Clinic 
8 Public Wards, D & E 
9 Public Ward F; 
D,E,F, Future Surg. Clin. 
10 Public Ward G 
11 Public Wards M & O; 
G,M,O, Future Med. Clin. 
12 Woman’s Clinic 
13 Institute of Pathology 
14 Dispensary Bldg., incl. 
15 Research Labs. & Operat- 
ing Dept. 
16 Present Nurses Home 
Annex, Future Eye Clinic 
16aFuture Eye Clinic 
17 Nurses Home 
18 Harriet Lane Home for 
Invalid Children 
19 Henry Phipps Psychiatric 
Clinic 
20 Laundry 
21 Proposed Nurses Home 
Mepicat ScHOOL 
22 Anatomy Building 
23 Hunterian Laboratory 
24 Old Hunterian Laboratory 
25 Physiology Bldg., incl. 
Physiological Chemistry 
& Pharmacology 
26 Scuoot oF HYGIENE 
27 Central Power & Heating 
lant 


MON UM EN T 


ing wholly new buildings. The accom- 
panying drawing illustrates how two 
old wards, similar to those which now 
house the Medical Clinic, were recon- 
structed in the building of the Woman’s 
Clinic, which adjoins them. 





Mme ELDERR YY 


J USSF OF ESR SOON 


—CWOO 
Le) 


One Story Corridors 


ENDOWMENT OF FREE BEDS 


These clinics are devoted chiefly to the 
care of free patients or patients who pay 
but a fraction of the cost of their care and 
treatment. Their enlargement will call for 
additional endowment for the free care of 


RUS BU TURE 27 


le 
SENT ME 


The New Medical Clinic will be built by remodeling the two old wards [Gand M-O]} connecting 


them, and by constructing additional stories on the old foundations, as was done in ae the 
D,Eond F 





Woman's Clunic. The new Burgical Clinic will be handled in a sumiar manner, using the old wards 








additional patients therein. Each of these 
clinics must have $1,500,000 in endow- 
ment for their operation when recon- 
structed. The Hospital hopes, however, 
to build up a considerable portion of these 


funds by the endowment of memorial 
beds. The cost of endowing such a bed so 
that it may be devoted to free care in per- 
petuity is $20,000. 


1. NERVOUS DISEASES 


Finally, in order to completely round out 
the group of clinical institutes at Johns 
Hopkins, a Neurological Clinic should be 
established. At the present time America 
has no great institutes for the research, 
study and treatment in the field of nerv- 
ous diseases such as exist in Europe and 
particularly in England. As the Johns 
Hopkins Hospital already has the Phipps 
Psychiatric Clinic for mental diseases, it 
is most logical that there should be es- 
tablished here a neurological clinic. The 
nervous and the mental diseases are so 
closely related that the existing and the 
proposed clinic would each supplement in 
a most effective manner the work of the 
other. 


TO MEET A NATIONAL NEED 


The proposed Neurological Clinic would 
be devoted to the study and treatment of 
such diseases as neuritis, hydrocephalus 
(water on the brain), traumatism (injury 
to the nervous system), tumors of the 
brain, paralysis, and like afflictions. Its 
establishment would be an advantage 
not only to the patients who come to 
Johns Hopkins from all parts of the 
country but would also be a contribution 
to hospitals and medical schools in all 
parts of this country through providing 
facilities such as now do not exist in 
America for the training of the neurolo- 
gists of hospital staffs and of medical 
school faculties. 


28 THE JOHNS HOPKINS HOSPITAL 


tv. CONVALESCENT BRANCH 


There is one way in which the service as a 
whole can be increased materially with- 
out the addition of a single bed to the 
Hospital proper. This can be accom- 
plished by the establishment of a con- 
valescent branch in the country for pa- 
tients who are on the road to recovery 
but yet not well enough to return to their 
homes. This would shorten the average 
stay of patients in the Hospital proper 


and enable it to care for a larger number 
of critical cases. The recovery of patients 
can also be hastened materially if they 
are removed from the city and from strict- 
ly hospital surroundings as soon as they 
become convalescent. It will cost $200,000 
to build and $600,000 to endow an ade- 
quate convalescent branch of the Johns 
Hopkins Hospital such as would be ade- 


quate to meet its needs. 


v. NURSES HOME 


In the private pavilion, in the wards, in 
operating rooms, and clinics, physicians 
and surgeons come and go. They spend 
only an hour or two with a patient at any 
one time and frequently but a few min- 
utes. Yet every minute of the night and 
day each patient is under the constant 
care of a nurse. A nurse is at the bedside 
or within sight and call all the time. On 
whether she does or does not carry out her 
mission faithfully hang the lives of pa- 
tients and the reputations of hospitals. 
The morale of the nursing corps therefore 
is of the utmost importance. 

It has been demonstrated that this 


morale flourishes best whenstudent nurses, 
resident nurses and head nurses not only 
work together but also live together as 
one family group. At the present time 
many of the student nurses are quartered 
in old buildings outside the Hospital, the 
nurses’ quarters in the Hospital are not 
unified, and a part of them must soon be 
taken over for other purposes. For this 
reason the Johns Hopkins Hospital 
about to let the contract for a new Nurses 
Home which will cost upward of $650,000 
or $700,000. This is one of the most press- 
ing needs of the present program and will 
have to be met immediately. 


vi. SCHOOL FOR NURSES 


The Hospital also is seeking $500,000 for 
the endowment of the School for Nurses. 
As an educational institution this school 
is at present dependent on the general 
funds of the Hospital and has no fixed in- 
come of its own on which it can rely for 
support. The best of our schools, colleges, 
and universities are endowed institutions 
or receive their income directly from the 


State and not as an indefinite part of 
some other appropriation. The foremost 
authorities on nursing education are of 
the opinion that this profession, in which 
women have proved their superior fitness 
almost to the total exclusion of men, will 
never be adequately provided for from 
the standpoint of education until its 
schools have independent endowment. 


29 


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that some of them are fully as vital to the 
Medical books—for the most part the 


TTS eT OVE, 








FR 





THE FUTURE HOME FOR NURSES 


(To be opened in 1926) 


To safeguard the system of education of to physicians,and to the whole public 


he public, health program. 


. 


nurses is most important to t 


vu. MEDICAL LIBRARY 


The needs of the Hospital are so closely 


related to those of the Medical School and schools as to the Hospital. 


the School of Hygiene and Public Health, 


30 


same books—are needed by the staff of 
the Hospital and the faculty and students 
of the schools. From the standpoint of 
numbers and the material they contain, 
the books at Johns Hopkins constitute 
one of the best medical libraries in this 
country. But these books as a whole are 
not easily available to all the men and 
women who are connected with the schools 
and the Hospital. The Hospital has its 
library. Each of the schools has its own. 


THE JOHNS HOPKINS HOSPITAL 


All these libraries are so limited in space 
that a large number of the books are scat- 
tered through various departments. The 
need for a central medical library build- 
ing therefore is great. It will cost in the 
neighborhood of $450,000 to build and 
$800,000 will be needed for its mainte- 
nance and the yearly acquisition of such 
new medical writings as are necessary to 
the study and treatment of disease and the 
pursuit of research. 


vil. HEATING AND POWER PLANT 


The Central Heating and Power Plant is 
also a joint enterprise which will serve the 
Medical School and the School of Hy- 
giene as well as the Hospital. Together 
they form a medical center which re- 
quires the power and light of a small city. 
Thus the plant, which is now being erected, 


will cost approximately $700,000, which, 
together with about $300,000 to be ex- 
pended in replacing antiquated heating 
and lighting systems in the older build- 
ings, will raise the entire cost of this proj- 
ect to the neighborhood of $1,000,000 
by the time it is complete. 


x. SERVICE BUILDING 


Beside the power plant, the general pro- 
gram will necessitate the erection of a new 
service building at a cost of $200,000, for 
the needs of provisioning the Hospital, 


preparing food for the staff and patients 
and providing additional storage room. 
The present service building already has 
been outgrown. 


x. CARE FOR PERSONS OF MODERATE MEANS 


One of the most common criticisms leveled 
against American hospitals in general is 
that, although they provide the best med- 
ical and surgical attention at their com- 
mand for the wealthy, who can pay for it, 
and provide free, or at a nominal charge, 
similarly good care for persons who have 
little or no money, they fail to provide 
equally well for persons of moderate 
means at a fee in keeping with their abil- 


ity to pay. 


The average clergyman, the average news- 
paper man, the average man or woman 
whose income return to the government 
does not include a surtax, is often in a 
grave dilemma when faced by the need 
of hospital care, particularly when the 
ailment is complex and acute. He hesi- 
tates to consult a number of specialists, 
as would a wealthy man. He also hesi- 
tates to go to the dispensary or wards 
of a hospital, knowing that the fees in 


EE SRP ORE. a 








Tr 





*GENERAL ENDOWMENT 

*MeEpIcAL CLinic 
SurcicaL Ciinic 

*CHILDREN’S DISEASES . 
Nervous DISEASES 

*Nurses HoMeE AND SCHOOL 
CoNnvVALESCENT BRANCH 

*MeEpICAL LIBRARY . : 

*HEATING AND Power PLanr . 
SERVICE BUILDING . a herb 3 
Diacnostic Ciinic FoR PERSONS OF 

Moperate MEans 


Norte: The items indicated with a star are those 
included in the immediate program which both 
the Hospital and the Medical School of the Uni- 
versity hope to finance before February 22, 1926. 
In this immediate program, $1,000,000 each in 
general endowment is being sought for both the 
Hospital and the Medical School. In addition, 
the Medical School is seeking $800,000 for the 





THE TEN YEAR PROGRAM FOR THE HOSPITAL 


CONSTRUCTION ENDOWMENT 
$2,000,000 
1,500,000 
1,500,000 
1,000,000 
1,000,000 
500,000 


TOTAL 
$2,000,000 
2,150,000 
2,150,000 
1,000,000 
1,750,000 
1,150,000 
800,000 
450,000 
1,000,000 
200,000 





200,000 
450,000 
1,000,000 





500,000 


$4,550,000 $8,600,000 $13,150,000 


endowment of the Central Library. All the items 
of the immediate program total $8,550,000. 
Toward this amount $3,500,000 has been re- 
ceived from the General Education Board and 
$85,000 from graduates of the School for Nurses. 
Thus the net total which is necessary to carry out 
the immediate program for medical needs at 
Johns Hopkins is $4,965,000. 








these services are set for the accommoda- 
tion of those who have little or no money. 
In consequence, the person of moderate 
means often endeavors to shift as best he 
can without going to a hospital and, as a 
result, often suffers irretrievably. 


THE SOLUTION 


To meet this situation the Johns Hopkins 
Hospital will establish, in its new and 
more ample Dispensary Building, a diag- 
nostic clinic for persons of moderate 
means where such a patient may come 








with his family physician and receive, for 
a moderate fee, all the benefits of diag- 
nosis by specialists in the various medical 
sciences which have a bearing on his in- 
dividual condition. Not infrequently, how- 
ever, the patient will need care in a hos- 
pital bed, and will be able to pay more 
than the ward rate but less than the rate 
for private patients. The Hospital can- 
not admit many of them as private pa- 
tients unless it has at its disposal a sufh- 
cient fund from which the difference be- 
tween what the patient can pay and the 
cost of private care can be made up. 


UNIVERSITY OF ILLINO!S 
LIBRARY-CHEMIS 


y 


22 THE JOHNS HOPKINS HOSPITAL 


THE COST 


It is estimated that an endowment of 
$500,000 will be adequate to provide suf- 
ficient income both for this purpose and 


for making up the deficiency between the 
fees of such patients and the cost of oper- 
ating a diagnostic clinic for persons of 
moderate means. 


x1. GENERAL ENDOWMENT 


There yet remains one more thing to in- Clinical Chemistry Laboratory... . . $100,000 


sure the success and stability of the Hos- 
pital’s future program. This is the need 
for $2,000,000 in general endowment. 
Half of this sum is needed within the next 
few months to provide for the proper op- 
eration of services which are now without 
adequate funds. To be of the greatest 
benefit this fund should be unrestricted, 
yet the same result could be gained by 
endowment for various services now being 
supported from the general income. These 
include: 


Clinical Bacteriological Laboratory 100,000 

Clinical Serological Laboratory. . 100,000 
(Preparation of Serums and Vaccines) 

Physiological and Cardiographic 
Laboratoriesi:.¢2-. A ee $200,000 
(Diagnosis of physical action of the heart 
and other bodily organs) 

(All the above laboratories are used mainly for the active 

work in diagnosing the disease and aiding in the treat- 

ment of patients.) 

Social Service.c Gy, (a) ee Gee $5 


Dietetic Department and School... 200,000 
Appliances for Crippled Children... 50,000 
Dental Care n22 025s Se 50,000 
Cate of Sick Nurses. 5. eee 50,000 
Hospital Publications. . 25,000 
Endowed Beds and Rooms for Free 

Caré.c3t. 5 oa) ey eee 15,000 to 35,000 


xu. FINANCES 


The last item of the program, general en- 
dowment, calls for an explanation of the 
present financial status of the Hospital. 
This institution receives no governmental 
support, Federal, State or Municipal. It is 
primarily an endowed institution. Its 
growth has been made possible by gifts 
from individuals and foundations which 
have sought in this manner to invest for 
the welfare of humanity. The bulk of these 
funds, however, has been given for spe- 
cial purposes rather than for the support 
of the Hospital as a whole. 

Despite the fact that it is now caring fora 
yearly total of approximately five times as 
many patients as the average during the 
first few years of its operation, and despite 
the fact that costs in general are more 
than twice that of thirty-six years ago, 


INCOME 









ENDOWMENT AND 
SPECIAL FUNDS 
$341,715.69 






PRIVATE 
PATIENTS 
$414,310.12 







the total productive endowment of the 
Hospital has not begun to keep pace with 


ETS eC RAE 


these increases. The present total for the 
support of this 683-bed hospital is $6,134,- 
714.00. This is less than twice the sizeof 
the productive endowment which was at 
the disposal of the Hospital in 1889 for 
the operation of 230 beds. 


INCOME FROM GENERAL ENDOWMENT HAS FAILED TO KEEP 
PACE WITH OPERATING COSTS—1905 THROUGH 1924 


05 06 0708 09 10 Ii 12: IS i4 1S 16 [7 18 


9 20 2) 22 23 24 





GENERAL ENDOWMENT 


Even now $1,974,088.53 of the productive 
endowment is restricted for special pur- 
poses. This means that the total general 
endowment, on which the Hospital must 
depend in the main for support, in addi- 
tion to fees and other charges, is but 
$4,160,623.82. This sum includes Johns 
Hopkins original gift of $3,228,404.84 
and means that $932,218.98 is the sum of 
all additional general endowment that 
the Hospital has received since 1889. 


DOES NOT PAY FREE CARE COST 


The income from all endowment is $341,- 
713.69 a year. This amounts to approxi- 
mately only 70 per cent. of the annual 
amount the Hospital is spending on free 
care. 

The question naturally arises: How has 
the Johns Hopkins Hospital, in the face 
of rising costs and increasing numbers of 
patients and despite the fact that it limits 
the fees of even the 20 per cent. of its pa- 
tients who can pay all or more than the 
cost of their treatment, how has it, in 


33 


spite of these facts, kept free from debt 
and continued to increase its usefulness? 


EFFICIENT OPERATION 


The Medical School bears a large portion 
of the salaries paid to the staff but the 
chief answer to the question lies in the fact 
that the Hospital, which has been a 
model of adminstration, has been able to 
maintain its high standard of treatment 
and care at an average daily cost per pa- 
tient of $5.08. The report of the General 
Hospital Fund has shown this to be much 
less than the average operating expense 
of metropolitan hospitals throughout the 
East. 


MAXIMUM RETURN ON INVESTMENTS 
Although the funds of the Hospital are 


conservatively invested it receives an 
average return of 5.46 per cent. This is 
conceded to be as much as can be hoped 
for in consideration of the factors of safety 
which must be maintained in the invest- 
ments of such an institution. Both from 
investments and from administration the 
authorities of the Hospital are convinced 
that they are obtaining the maximum re- 
turn from their money, but there is no 
margin to fortify the institution against 
any general financial depression and there 
is grave need of additional endowment to 
ballast the general development program 
which is now being undertaken. 


PROGRESS OR RETROGRESSION? 


The cost of operating the Hospital during 
1924 resulted in a deficit of $41,000. This 
means that unless additional general en- 
dowment is obtained the Hospital must 
stint its services for the present year and 
retrogress instead of going forward. 


MEMORIALS 


5/5 the Johns Hopkins Hospital serves the entire na- 
tion it is appealing to the nation as a whole for the 
support of its program, and particularly to the 
people of Baltimore ,New York andthe other large 





cities of the East and South from which a great 
number of its patients come. Its authorities are convinced that its 
major needs constitute a series of outstanding opportunities for 
those who wish to establish memorials that will be monuments of 
lasting benefit to mankind. 


MEMORIAL GIFTS may serve as the basis for establishing 
In addition to the major projects of the memorials. A number of these are classi- 
program there are a number of special fied in the following list under the amounts 
funds, included in the totals, which well needed for each. 
$100,000 


CLINICAL CHEMISTRY LABORATORY CLINICAL BACTERIOLOGICAL LABORATORY 
CLINICAL SEROLOGICAL LABORATORY 


$50,000 


ENDOWMENT FOR THE PURCHASE OF APPLIANCES FOR CRIPPLED CHILDREN 
ENDOWMENT FOR THE CARE OF SICK NURSES 
MEMORIAL INSTRUCTORSHIP IN THE SCHOOL FOR NURSES 


$35,000 
ENDOWED PRIVATE ROOMS 
$30,000 
ENDOWED BEDS IN THE PHIPPS PSYCHIATRIC CLINIC 
$25,000 


ENDOWMENT FOR THE HOSPITAL PUBLICATIONS 
ENDOWED CUBICLES 


$20,000 


ENDOWED BEDS IN GENERAL SERVICE 


MEMORIALS aK 


$15,000 


ENDOWED BEDS IN THE HARRIET LANE HOME 


$1,000 


MEMORIAL ENDOWMENT FUNDS TO PAY FOR THE FREE CARE OF ONE 
PATIENT FOR TEN DAYS EACH YEAR AT THE RATE OF $5.00 A DAY 


It is likely that a considerable portion 
of the endowment needed for the support 
of free care in the enlarged medical and 
surgical wards, or in meeting the emer- 
gency situation in the care of children, 
will be made up of single memorial beds. 
The laboratories included in this list are 
now dependent for support on the re- 
stricted present endowment, yet on them 
depend in large part the diagnosis of dis- 
ease in the Hospital and the preparation 


of the antitoxins and serums which are 
among the most effective weapons for the 
conquest of many diseases. 

In the last analysis, however, any gift, 
no matter how large or how small and no 
matter whether or not it is designated as 
a memorial, is in reality a memorial—a 
lasting memorial which will live on, gen- 
eration after generation, in the lives of 
those who benefit by the work of the Johns 
Hopkins Hospital. 


(It has been possible, herein, to give but a limited outline of both the work 

and the needs of the Fohns Hopkins Hospital. Further information concern- 

ing these subjects can be obtained from the office of the Fohns Hopkins Half- 
Century Committee, 603 Keyser Building, Baltimore). 





THE JOHNS HOPKINS 
HOSPITAL 


y 


POINTS OF DISTINCTION AND INTERESTING FACTS 


| Pehoe American hospital to integrate its work 
with the activities of a medical school in 
such a manner that patients might obtain the 
full benefit of the foremost advances in 
medical knowledge. 


@ First hospital to be associated with a school 
of Hygiene and Public Health which seeks 
knowledge to prevent disease before there is 
need for a cure. 


@ Includes in its medical group a number of 
clinical institutes, which are special hospitals 
in themselves. These include the Woman’s 
Clinic, the Harriet Lane Home (Children’s 
Diseases), the Phipps Clinic (Mental Dis- 
eases) and the Brady Urological Institute 
(Genito-Urinary Diseases), and will soon in- 
clude the Wilmer Institute for diseases of the 
eye. 


@ Research seeking better and more effective 
methods to combat disease is carried on in 
every department. 


@ Educational activities include the training 
of medical students, hospital executives, re- 
search workers, nurses and dieticians and the 
postgraduate training of physicians. 


@ Patients and students come to it from all 
parts of the United States and from many 
foreign countries. 


@ Its publications give the benefit of medical 
discoveries to the world in general. 


@ Strives to teach patients how to stay well 
after they are cured. 


@Social Service Department combats fac- 
tors other than medical which impede the 
recovery of patients. 


@Seventy-nine per cent. of its patients are 
treated at less than cost and more than half 
of these are free patients. 


@ Patients are admitted solely with regard to 
the seriousness of their illness and without re- 
gard to race, creed, color, social condition, or 
ability to pay. 


@ Approximately one-fourth of its patients 
are colored people. 


@ Half the crippled children of Baltimore 
alone have received treatment through the 
Orthopedic service. 


@_Bed patients cared for since 1889 total 
190,347. 


@Total days of treatment given patients 
since 1889, approximately 3,303,400. 


@ Total visits to the Dispensary in the same 
period, approximately 3,127,000. 


@ Although the yearly number of bed pa- 
tients increased from 1,890 in 1890 to 10,171 
in 1924, the Hospital’s general endowment in- 
creased but one-third in that period. 


@ During the war it equipped and staffed 
throughout a 500-bed military hospital, the 
first to sail overseas with a contingent of 
American troops. 


THE JOHNS HOPKINS 
HALF-CENTURY COMMITTEE 


603 KEYSER BUILDING 
BALTIMORE 


DanieL WILLARD, General Chairman 


SEWARD Prosser, Treasurer 


JosEpH S. AMES 
Epwin G. BAETJER 


Newton D. Baker, 


LeweELtys F. Barker, M.D. 


Tuomas R. Brown, M.D. 
Frep G. Boyce, Jr. 
Davin J. CARVER 

H. A. B. Dunnino 
Cuar_es K. Epmunps 
Ricuarp H. Foutuis, M.D. 
FRANK A. Furst 

F. H. German 

Joun M. GLENN 

Frank J. Goopnow 


B. HowE i Griswo.p, Jr. 


Henry D. Haran 
Wivuram H. Howe. 

R. Brent KEYSER 
Rosert G. Merrick 
SipneEy R. Mitier, M.D. 
Joun R. Ottver, M.D. 
ALEXANDER RANDALL 
BLANCHARD RANDALL 
Rosert H. RILey 

Juxian D. Sears 
Winrorp H. Situ, M.D. 
Gen. GEorGE O. SQuiIER 
Henry L. Straus 

W. Stuart SyMIncTON, JR. 
Lewis H. WEEp, M.D. 


WivuiraM H. We cu, M.D. 







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UNIVEPSITY OF ILLINT 3 


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